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History: Two Hundred Years since MalthusAuthor(s): John A. BlackReviewed work(s):Source: BMJ: British Medical Journal, Vol. 315, No. 7123 (Dec. 20 - 27, 1997), pp. 1686-1689Published by: BMJ Publishing GroupStable URL: http://www.jstor.org/stable/25176579 .
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8/18/2019 200 Years Since Malthus
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Education
and debate
the first
and
only
instance
I
have
come
across
in
which
hallucinatory
voices
sought
to
reassure
the
patient
of
their
genuine
interest
in
her
welfare,
offered
her
a
spe
cific
diagnosis
(there
were no
clinical
signs
that would
have
alerted
anyone
to
the
tumour),
directed
her
to
the
type
of
hospital
best
equipped
to
deal with her
problem,
expressed pleasure
that
she
had
at
last
received
the
treatment
they
desired
for
her,
bid
her
farewell,
and
thereafter
disappeared.
I
presented
her
case
at
a
conference
later
that
year.
AB
attended and
was
closely
questioned by
several
people
about the various
aspects
of her
experience.
The audience
was
split
down
the
middle.
People
who
would be
called
X-philes
today
rejoiced
that
what
had
happened
to
her
was a
clear
instance of
telepathic
communication
from
two
well
meaning people
who
had,
psychically,
found
that AB
had
a
tumour
and
sought
to
help
her.
The
X-phobes
had
a
very
different formulation.
According to them,AB had been given the diagnosis of
a
brain
tumour
in
her
original
country
and wanted
to
be treated
free
under
the
NHS.
Hence,
they
surmised,
she had
made
up
the
convoluted
tale about voices tell-
'
ing
her this and
that
But AB
had lived
in
Britain for
15
years
and
was
entitled
to
NHS
treatment
Besides,
she
had
been
so
relieved
when
the
voices
first
disappeared
on
thioridazine that
she
had
gone
on
holiday
to
celebrate the
recovery
of her
sanity.
There
was a
group
at
the
case
conference who
offered
a
different
opinion.
Their
view
was
that,
the
total
lack of
physical signs notwithstanding,
it
was
unlikely
that
a
tumour
of
that
size
had had
absolutely
no
effect
on
the
patient
She
must
have
felt
something, they argued.
They
suggested
that
a
funny
feeling
in
her head
had
led her
to
fear
that
she had
a
brain
tumour.
That
fear
had led
to
her
experience
of
hallucinatory
voices. She
may
have
unconsciously
taken
in
more
information about various
hospitals
than she
realised,
and this
information
was
reproduced
by
her
mind
as
part
of
the
auditory
hallucinatory
experience.
The
voices
expressing
satisfaction
with the
outcome
of her
treatment
were
her
own
mind
express
ing
its
relief that the
emergency
was over.
And the total
disappearance of psychiatric symptoms after the
removal
of
the
tumour
showed
that these
symptoms
were
at
least
direcdy
related
to
the
presence
of the
lesion-and
may,
in
fact,
have been
produced
by
the
lesion
itself.
I
have obtained the
patient's
signed
consent
to
publication.
History
Two
hundred
years
since
Malthus
John
A Black
Victoria
Mill
House,
Framlingham,
Woodbridge,
Suffolk
IP13
9EG
John
A
Black,
retired consultant
paediatrician
BMJ
1997;315:1686-9
Malthus
was
by
training
a
mathematician
and
by
profession
a
teacher of
political
economy,
but his work
was
greatly
influenced
by
his
Christian convictions.
In
the first edition of his
Essay,
published
in
1798,
he
put
forward the
hypothesis
that
population,
if
unchecked,
would
increase
by
geometrical
ratio,
doubling
itself
every
25
years,
while food
supply
could increase
by
only
arithmetical ratio. He
suggested
that
population
was
controlled
by
positive
checks
such
as
war,
famine,
and disease.
He
campaigned
unsuccessfully
for the
gradual
abolition
of
the
old
poor
laws
which,
he
thought,
encouraged
the
working
class
to
marry young
and
to
have
large
families.
In his
second
edition he introduced
the
concept
of the
preventive
checks
by
moral
restraint?late
marriage
and restraint within
marriage.
The
reduction
in
fertility
which
Malthus advocated
was
achieved
by
the
acceptance
of birth
control,
to
which
he
was
violently opposed.
He
was
attacked
during
his
lifetime
and
has
been
misinterpreted
and misunder
stood
ever
since.
Academic
career
Thomas Robert
Malthus
(known
as
Robert)
(fig
1)
was
born
on
14
February
1766
near
Dorking, Surrey.
He
was
born
with
a
cleft
lip
and
palate,
but this
does
not
seem
to
have
hindered his academic
career.
In
1785
he entered
Jesus College, Cambridge,
where
he read
mathematics,
obtaining
a
first class
degree.
He
was
elected fellow of the
college
in
1797,
and
four
years
later took
Holy
Orders.
In
1805
he
was
appointed
professor
of
history
and
political
economy
at
the
newly
founded
College
of the
East India
Company,
at
Haileybury,
in
Hertfordshire
(now
Haileybury
and
Imperial
Service
College).
He held this
post
until
his
death
in
1834
from disease
of
the
heart
in
Bath
(fig
2).
He married
at
the
age
of 38 and
had three
children.
Positive
checks
to
population
Reacting
against
his father's enthusiasm
for the
Utopian
ideas
of the
Marquis
de
Condorcet
and
William
Godwin,
Malthus
published
the first
edition
of
his
essay
as
a
long
pamphlet
in
1798
(fig
3).
Its
full
tide
was
An
essay
on
the
principle
of
population
as
it
affects the
future
improvement
of
society.
With
remarks
on
the
speculations
of
Mr.
Goodwin,
M.
Condorcet,
and
other
writers. 1
He
set
out
his
views
clearly:
The
power
of
popula
tion is
infinitely greater
than the
power
in
the earth
to
produce
subsistence
for
man.
Population
when
unchecked,
increases
in
a
geometrical
ratio.
Subsist
ence
increases
only
in arithmetical
ratio
...
By
that law
of
our
nature
which
makes
food
necessary
to
the life of
man,
the effects of
these
two
unequal
powers
must
be
kept equal.
This
implies
a
strong
and
constandy
oper
ating
check
on
population
from the
difficulty
of
subsistence.
1686
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Education and
debate
He defined the
checks
as
follows: The
positive
checks
to
population
are
extremely
various
...
Under
this
head, therefore,
may
be enumerated all unwhole
some
occupations,
severe
labour
and
exposure
to
the
seasons,
extreme
poverty,
bad
nursing
of
children,
great
towns,
excesses
of all
kinds,
the whole train
of
common diseases and
epidemics,
wars,
plague
and
famines.
Summarising
his
views,
he
wrote:
The truth
is,
that
the
pressure
of
distress
on
this
part
of
a
community
[the
poor]
is
an
evil
so
deeply
seated
that
no
human
ingenuity
can
reach it
North
America
provided
the
evidence
that
population
could
increase
in
geometrical
ratio.
Malthus noted
that,
In the northern
states
of
America
...
the
population
has been
found
to
double
itself,
for above
a
century
and
a
half
successively
in
less
than
twenty-five
years
....
It
may
safely
be
pronounced
therefore,
that
population,
when
unchecked,
goes
on
doubling
itself
every
twenty-five
years,
or
increases
in
a
geometrical
ratio.
On
the
question
of food
supply,
he
wrote:
the
means
of
subsistence,
under circumstances
the
most
favourable
to
human
industry,
could
not
possibly
be
made
to
increase faster
than
in
an
arithmetical
ratio.
Preventive
checks
Malthus
visited
Germany,
Scandinavia,
and Russia
in
1799
and France
and
Switzerland
in
1802,
accumulat
ing
material,
which
was
incorporated
into
the second
edition,
published
in
1803,
under his
own
name.2
Significandy,
the subtitie
was
altered
to
Or
a
view of its
past
and
present
effects
on
human
happiness,
with
an
inquiry
into our
prospects
respecting
the future
removal
or
mitigation
of
the
evils which it occasions.
Fig
1 John
Linnell's
portrait
of Malthus
in
1833,
aged
67.
(Reproduced
with
permission
of
the
governors
of
Haileybury
and
Imperial
Service
College)
SACREDTO THE
MEMORY
OF
Wht
&eb.
gfl&otna*
Robert
iWalt&u*
LONG KNOWN
TO
THE LETTEREDWORLD
BY HIS
ADMIRABLE
WRITINGS
ON
THE SOCIAL
BRANCHESOF
POLITICAL
ECONOMY,
PARTICULARLYBY HI8
'ESSAY
ON
POPULATION'.
ONE
OF
THE BESTMEN
AND TRUEST PHILOSOPHERS
OF
A'NY
AGE OR
COUNTRY,
RAISED BY NATIVE DIGNITYOF MIND
ABOVE THE
MISREPRESENTATIONS
F THE IGNORANT
AND
THE
NEGLECT OF THE
GREAT,
HE
LIVED
A
SERENE
AND HAPPY
LIFE
DEVOTED
TO THE PURSUITAND COMMUNICATION
OF
TRUTH,
SUPPORTED
BY
A CALM BUT
FIRM CONVICTION
OF
THE
USEFULNESS
OF
HIS
LABOURS,
CONTENTWITH THE
APPROBATION
OF THE WISE
AND GOOD.
HIS WRITINGSWILL BE
A
LASTINGMONUMENT
OF
THE
EXTENT AND CORRECTNESS F HI8 UNDERSTANDING.
THE
SPOTLESS NTEGRITYOF HIS PRINCIPLES
THE
EQUITY
AND CANDOUROF HIS
NATURE,
HIS SWEETNESS F
TEMPER,
URBANITY OF
MANNERS,
AND
TENDERNESSOF HEART,
HIS
BENEVOLENCE ND HIS
PIETY,
ARE
THE STILL
DEARER RECOLLECTIONS
F HIS
FAMILY
AND FRIENDS
Born
14th
Feb.
1766.
Died
29
Dec.
1834.
Fig
2
Memorial
to
Malthus in Bath
Abbey. (From
The Malthusian
population
theory
by
G
F
McCleary.
London: Faber and
Faber,
1953.)
Appreciating
now
that
population
was
not
control
led
solely by positive
checks,
Malthus introduced the
concept
of
preventive
checks.
He divided them into
those
arising
from vice and
moral
restraint,
by
which he
meant
chaste
restraint from
marriage?that
is,
late
marriage
without
previous
sexual
liaisons,
and
restraint within
marriage,
with
voluntary
restriction of
the number
of
children. Preventive
checks
arising
from
vice
were:
Promiscuous
intercourse,
unnatural
pas
sions,
violations of the
marriage
bed,
and
improper
acts to
conceal the
consequences
of
irregular
connexions.
According
to
Malthus,
the
lower orders
had lost their self
respect
and
were
marrying
young
and
producing
more
children than
they
could
support
Malthus's solution
Malthus advocated the
gradual
abolition of the
poor
laws with
safeguards against
undue
distress,
but retain
ing
the threat
of
economic
hardship.
He
thought
that
the fear of
want,
rather than
want
itself,
that is the best
stimulus
to
industry.
In
spite
of this
approach
he
was
able
to
write
a
shockingly
repressive
passage
(not
in
the
sixth
edition):
A
man
is born
into
a
world
already possessed
if he
cannot
get
subsistence
from
his
parents
on
whom
he
has
a
just
demand,
and
if
society
do
not
want
his
labour,
has
no
claim
of
right
to
the
smallest
portion
of
food, and,
in
fact,
has
no
business
to
be where
he
is.
At
Nature's
mighty
feast
there
is
no
vacant
cover
for
him.
She tells
him
to
be
gone,
and
will
quickly
execute
her
orders. 2
Malthus
proposed
that the
working
classes should
copy
the habits of the
middle
classes,
who
married late
and had small families. He had
a
poor
opinion
of the
upper
classes: Those
among
the
higher
classes,
who
live
principally
in
towns,
often
want
the inclination
to
BMJ
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Education and debate
AN
ESSAY
ONTHE
PRINCIPLE
OF
POPULATION,
AS
IT
AFFECTS
THE FUTURE IMPROVEMENT
OF SOCIETY.
WITH
REMARKS
ON
THE
SPECULATIONS
OF MR.
GOODWIN,
M.
CONDORCET,
AND
OTHER
WRITERS.
LONDON:
PRINTED FOR
J.
JOHNSON,
IN
ST.
PAUL'S
CHURCH-YARD.
I798.
Fig
3 Title
page
of the first edition. Godwin's
name
is
misspelt
marry,
from the
facility
with which
they
can
indulge
themselves
in
an
illicit
intercourse with
the sex.
To
promote
his
views,
Malthus advocated universal
primary
education:
[We]
have been
miserably
deficient
It is
surely
a
national
disgrace,
that the
educa
tion of the lower classes of
people
in
England
should
be
left
merely
to
a
few
Sunday
Schools,
supported
by
a
subscription
from
individuals,
who
can
give
to
the
course
of
instruction
in
them
any
kind
of bias
which
they please.
The other side
of Malthus
Malthus had
a
humane
side
to
his
character. He
condemned the
social
evils
resulting
from the
industrial revolution
and
was
concerned about
the
ill
treatment
of
illegitimate
children and the
high
mortality
of
children in the towns. In
London,
accord
ing
to
former
calculations,
one
half
of
the born died
under
three
years
of
age.
He attributed this
to
poor
housing
and
atmos
pheric pollution:
There
certainly
seems
to
be
something
in
great
towns,
and
even
in
moderate
towns,
peculiarly
unfavourable
to
the
very
early
stages
of
life...
it arises
from
the closeness and
foulness of
the
air,
which
may
be
supposed
to
be
unfavourable
to
the
ten
der
lungs
of children.
Changes in England
To
understand Malthus's
ideas
and the
reasons
his
policies
failed,
it is
necessary
to
review the
social,
economic,
and
demographic changes
which
were
occurring
at
the
time. The economic situation
of
the
agricultural
labourers
was
deplorable.
The
enclosure
movement meant
that
they
had lost their
security
of
employment,
their
cottages,
and
the
common
rights
which had
given
them
some
independence.3
Many
families
became destitute
and
were
forced
to
live in
the
workhouses.
Between
1731
and 1811 the
population
almost
doubled and the
price
of food increased two and a half
times.4
Concurrently,
fertility
was
rising, reaching
a
peak
in
1790,
and real
wages
were
falling,
with
a
nadir
in
1811
(fig
4).
On
6
May
1795
the
magistrates
at
Speenhamland
in
Berkshire,
in
an
effort
to
alleviate
distress,
introduced
supplementary
wages,
tied
to
the
price
of
bread,
for all
poor
and industrious
[employed]
men. This reduced the
agricultural
workers
to
dependent
paupers,
placed
an
intolerable
burden
on
the
parish,
and
encouraged
landowners
to
keep
wages
low.
Malthus
attributed
the
rising population
to
this
dependency
culture, which,
he
thought, encouraged
early marriage
and
large
families.
He
feared
social
unrest,
even
revolution,
due
to
food
shortages.
There
were
serious
food
riots
in
1816.
For
250
years
before
Malthus,
population
had
been
linked
to
the
price
of
food,
with the
prices
increasing
faster
than
population.
Between
1811 and
1871
the
population again
doubled,
but
this time
food
prices
fell,
then
stabilised;
this
was
due
to
improve
ments
in
agriculture
and
to
the
economies
of
scale
resulting
from the
enclosures.
Wages began
to
rise,
due
to
the
demand
for
labour
by
the industrial
revolu
tion,
and continued
to
rise
for
the
rest
of
the
century
(fig
4).
There
were
also
demographic
changes.
In
pre
industrial
England
the
working
classes
practised
virtu
ally
no
birth
control?coitus
interruptus
was
thought
to
be
injurious
to
health.
Fertility
was
determined
by
the
ability
of
a
couple
to
afford
to
marry
and have children.
This
meant
late
marriage
and small families.
Though
Malthus did
not
discuss
infanticide
or
abortion,
Darwin
regarded
infanticide,
particularly
of female
infants,
and
abortion,
as
important positive
checks.5
According
to
the
preindustrial
pattern,
the
coincidence
of
stable
food
prices
and
rising
wages
should
have
caused
fertility
to
rise.
Instead,
from
1840
&
900 3.6
j?
? ?Real wage5
?>
?Gross
reproduction
rate
?
|
800
*
/
3.2
|
700
/\/\
I
2'8
*
600
\J\
Is ^\
jr\
24
500
\\*J/
2-?
400
*^J
1.6
300
1-2
1551 1601 1651
1701
1751 1801 1851 1901
Fig
4
Gross
reproduction
rates in
five
year
cohorts
compared
with
25
year
moving
average
of real
wage
index. Gross
reproduction
rates,
which
were
used
by Wrigley
and Schofield
as an
index of
fertility,4
are
age
specific
birth
rates
of
women.
(Reproduced
from
The
Population History
of
England
1541-1871
with the
permission
of
the authors and
publishers)
1688
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Education and
debate
onwards,
fertility began
to
fall and
continued
to
fall
until
the
end of
the
century
(fig
4).
This
was
because
contraception
(the
vaginal
sponge
had
been intro
duced
from
France,
coitus
interruptus
was now
accept
able,
and
condoms
had been used
mainly
to
avoid
venereal
disease
from
prostitutes)
had
become
respect
able and
couples
were
choosing
to limit their families
and
to
enjoy
increased material comfort
Malthus
was
violentiy
opposed
to
contraception
and
only
referred
to
it
obliquely:
A
promiscuous
intercourse
to
such
a
degree
as
to
prevent
the birth of
children
seems
to
lower
in
the
most
marked
degree
the
dignity
of
human nature.
Conclusion
Malthus
advocated
several
socially
progressive
ideas
but
these
were never
implemented
in
his
lifetime.
His
social
policies
were
defeated
by
a
combination of
socioeconomic
progress
and
by
the
acceptance
of
an
effective
preventive
measure,
which he
had refused
to
recognise.
His
lasting
contributions, however,
were
the
concepts
of
the
tension between
population
and food
supply
and
the
positive
and
preventive
checks
to
population.
For almost
a
century
Malthus's ideas
were
regarded
as obsolete but the Club of Rome's The Limits toGrowth
revived the
Malthusian
analysis by pointing
out
the
limitations of food
supplies
and non-renewable
sources
of
material
and
energy
to
cope
with the
popu
lation
explosion.6
1
An
essay
on
the
principle
ofpopulation.
1st ed. London:
J Johnson,
1798.
2
Malthus
TR. An
essay
on
the
principle of
population.
2nd
ed. London:
J John
son,
1803:531.
3
Hammond
JL,
Hammond
B. The
village
labourer
1760 -1832.
Abingdon:
Fraser
Stewart,
1995:100.
4
Wrigley
EA,
Schofield RS.
The
population
history
of England
1541-1871.
London:
Arnold,
1981:403.
5 Darwin C. The
descent
of
man
and selection
in relation
to
sex.
London: Mur
ray,
1871:134.
6 Meadows
DH,
Meadows
DL,
Randers
J,
Behrens
WH.
The limits
to
growth.
New
York: Universe
Books,
1972.
Sailors
and
star-bursts,
and
the
arrival
of HTV
Edward
Hooper
Tracking
the
origins
and
early history
of
a
newly
recognised
disease is
more
than
just
an
academic
exercise. To
appreciate
how
a
disease
began
can
help
medical science
to
combat it The classic
example
is
John
Snow's
investigation
of the cholera
epidemic
in
Golden
Square,
London,
in
1854:
his
removal
of the
handle of
the Broad Street
pump
contained
the
outbreak.1
An
appreciation
of
causation
may
also
help
to
prevent
similar
events
occurring
in
the future.
The
recent
evidence,
for
example,
about the
origins
of
new
variant
Creutzfeldt-Jakob
disease2
3
will,
hopefully,
sen
sitise
those
research
scientists
who
are
transplanting
baboon livers
in
humans
to
the
potentially
catastrophic
impact
of
zoonoses?human
diseases
acquired
from
animals.4
Three outbreaks
of
AIDS
...
In
the
case
of
AIDS,
three related but distinct
causes
have been
recognised
in
the
past
16
years?namely
the
three
human
immunodeficiency
viruses
(HIV-2
and
HIV-1
groups
M
and
O).
It is
now
widely
accepted
that
HIV-2
is
the
result
of
a
zoonotic
transfer
of
a
simian
immunodeficiency
virus
from the
sooty
mangabey
(a
species
of African
monkey).
HIV-1
groups
M
(for
main )
and O
( oudier )
seem
to
result
from
two
sepa
rate
zoonotic
transfers of different variants
of
simian
immunodeficiency
virus
in
chimpanzees.
HIV-1 group M has
probably
caused over 99% of
the world's
12.9
million cumulative AIDS
cases to
date5;
by
contrast,
group
O has
probably
caused
less than
0.1%,
perhaps
because
the virus
(like HIV-2)
is less
transmissible.
None the
less,
the
rarer
HIV-1
may
also
have
lessons
to
teach
us.
Summary
points
Learning
about
the
origins
of
a
disease
may
help
us
to
control
it
and
also
to
prevent
similar
diseases
arising
in
the future
The earliest
confirmed
case
of AIDS
in
the
world
was
in
a
young
Norwegian
sailor
who
was
infected
with
HIV-1
group
O?probably
in
Cameroon
in
1961-2
The earliest evidence of
HIV-1
group
M is
rom
1959
and of
HIV-2
from 1965. It
seems,
therefore,
that all three HIVs
may
have
emerged
around the
same
time
Phylogenetic
evidence
shows
that
HIV-1
groups
I
M
and
O
show
a
star-burst
phylogeny,
with
j
different
subtypes suddenly emerging
around
1959
Opinion
is
divided about
whether this star-burst
arose
from
the natural transfer of
simian
| immunodeficiency
virus
to
humans
or
from
iatrogenic
introduction?for
example,
through
a
I
vaccine
Two
mariners
...
Earlier
this
year,
characterisation
by
polymerase
chain
reaction
sequencing
of
an
archival
HIV-1 isolate
from
a
29
year
old
Norwegian
former
merchant
seaman
showed
that
he had been
infected
with
a
group
O
PO
Box
4087,
Worthing
BN14
7LQ
Edward Hooper,
writer and
medical
researcher
BMJ
1997;315:1689-91
BMJ
VOLUME
315
20-27
DECEMBER
1997
1689